This project is designed to develop both operative and nonoperative regimens to improve the duration and quality of life of patients with cirrhosis. Our primary objective is to quantitatively define the physiologic and clinical response of patients with cirrhosis treated with transsplenic decompression (distal splenorenal shunt). Studies initiated in 1971 on a prospective, randomized basis have shown the distal splenorenal shunt, while controlling gastroesophageal bleeding, significantly decreases the morbid postoperative complication of encephalopathy. At present, the emphasis of our studies has shifted to a study of the long-term followup of patients in this prospective, randomized study. Reevaluation of patients from this prospective study has once again defined the crucial importance of developing a method for quantitatively measuring sinusoidal blood flow. In addition to developing a method for measuring portal blood flow, the encephalopathy potential or capacity of proteins, groups of amino acids, and individual amino acids, is actively being pursued. Defining this syndrome of subclinical encephalopathy will allow closer scrutiny of patients treated with distal splenorenal shunt and traditional total shunts. The use of the LeVeen shunt in treating the postoperative ascites which can occur with distal splenorenal shunt has been described. Our study of this method will continue and will incorporate control populations with noncirrhotic ascites in an attempt to better quantitate the effect of this shunt on renal blood flow and hematologic parameters. BIBLIOGRAPHIC REFERENCES: Galambos, J.T., Warren, W.D., Rudman, D.: Portal surgery and liver function: A new look at an old problem. Mt. Sinai. J. Med. 43:219, 1976. Khatra B.W., Chawla R.K., Sewell C.W., Rudman D.: Distribution of branched-chain a-keto acid dehydrogenases in primate tissues. J. Clin. Invest. 69:558-564, 1977.